Serum albumin is an essential plasma protein, with a variety of homeostatic and predictive roles in health and disease. Hypoalbuminaemia is common in critical illness. Human albumin solution has been administered clinically for more than five decades, but its use has been subject to marked controversy for the last twenty years. This has shaped not just day-to-day practice in the intensive care unit (ICU), but also the evolution of international, multicentre randomised controlled trials (RCTs) in critical care.

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